Pneumonectomy
A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. It was first
successfully performed in 1933 by Dr. Evarts Graham. This is not to be confused with a
lobectomy or segmentectomy, which only removes one part of the lung.
There are two types of pneumonectomy: simple and extrapleural. A simple pneumonectomy
removes just the lung. An extrapleural pneumonectomy also takes away part of the
diaphragm, the parietal pleura, and the pericardium on that side.
Indications
The most common reason for a pneumonectomy is to remove tumorous tissue arising
from lung cancer. Other reasons can arise are a traumatic lung injury, bronchiectasis,
tuberculosis, a congenital defect, and fungal infections.
Contraindications
Tests
The operation will reduce the respiratory capacity of the patient, and before conducting a
pneumonectomy, survivability after the removal has to be assessed. If at all possible,
a pulmonary function test (PFT) should be done. It has been found that forced expiratory
volume in one second (FEV1) and diffusion capacity of the lungs (DLCO) provides the best
indicator of survival.
Pathologies
If someone has severe valvular disease, severe pulmonary hypertension, or poor ventricular
function or if cancer has spread from the lungs into the other intra-abdominal structures,
ribs, or contralateral hemithorax, it is contraindicated.
Surgical approach
Posterolateral thoracotomy using the fourth or fifth intercostal space is the most common
approach used for pneumonectomy. In case of inflammatory and infectious indications,
excision of the fifth rib may be necessary to achieve adequate surgical exposure if there is rib
crowding.
Video-assisted thoracoscopic surgery (VATS) approach: VATS pneumonectomy is a safe and
feasible treatment for advanced malignant and benign diseases and has lower morbidity.[7]
Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to
thoracotomy. With a sound technique most procedures can be completed robotically
without any major complications.
Anatomical changes
After a pneumonectomy is performed, changes in the thoracic cavity occur to compensate
for the altered anatomy. The remaining lung hyperinflates as well as shifting over along with
the heart towards the now empty space. This space is full of air initially after surgery, but
then it is absorbed, and fluid eventually takes its place.[9] The fluid which fills the residual
space in the chest cavity slowly gelatinizes into a proteinaceous material, and the chest
scaffold collapses slightly.
X-ray of a person who has had their right lung
removed. Note how fluid has replaced the lung
Living with one lung[edit]
As with the kidneys, it is often possible for a person to live with just one lung. Although it is
not possible for the lung to re-grow like the liver, the body is able to compensate for the
reduced lung capacity by slow and gradual expansion of the other remaining lung. Post-
pneumonectomy patients in due time reach about 70–80 percent of their pre-surgery lung
function.People have been able to return to near-normal lives, including running marathons
after a pneumonectomy, provided there has been adequate cardio-pulmonary conditioning.
Complications
Most common complications after a pneumonectomy are:
Cardiac arrhythmias[12]
Pulmonary complications like pneumonia, atelectasis, respiratory failure[13]
Bronchopleural fistula[14]
Injury to the diaphragm, liver, spleen, or a major vessel
Postpneumonectomy pulmonary edema[15]
Postpneumonectomy cardiac herniation
Lung lobectomy
A lobectomy of the lung is performed in early-stage non-small cell lung cancer patients.[2]
[3] It is not performed on patients that have lung cancer that has spread to other parts of the
body. Tumor size, type, and location are major factors as to whether a lobectomy is
performed. This can be due to cancer or smoking. Lung lobectomies are performed on
patients as young as eleven or twelve who have no cancer or smoking history, but have
conditions from birth or early childhood that necessitate the operation.[4][5] Such patients
will have reduced lung capacity which tends to limit their range of activities through life.
They often need to use inhalers on a daily basis, and are often classified as being asthmatic
Segmental resection
Segmental resection (or segmentectomy) is a surgical procedure to remove
part of an organ or gland, as a sub-type of a resection. It may also be used to
remove a tumor and normal tissue around it. In lung cancer surgery, segmental
resection refers to removing a section of a lobe of the lung. The resection
margin is the edge of the removed tissue; it is important that this shows free of
cancerous cells on examination by a pathologist.
